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Open arterial duct: symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 04.07.2025
The arterial (Botallo's) duct is a necessary anatomical structure that, together with the oval window and the ductus arteriosus, provides the embryonic type of fetal blood circulation. The patent ductus arteriosus is a vessel that connects the thoracic aorta with the pulmonary artery. Normally, the function of the arterial duct ceases several hours (no more than 15-20) after birth, and the anatomical closure continues for 2-8 weeks. The duct turns into an arterial ligament. If the duct does not close, blood from the aorta is discharged into the pulmonary artery, and the pressure in the pulmonary circulation increases. Blood is discharged in both phases of the cardiac cycle, since both in systole and diastole the pressure in the aorta is significantly higher than in the pulmonary artery (pressure gradient of at least 80 mm Hg).
[ Symptoms of Patent Ductus Arteriosus
On palpation, systolic tremor is detected at the base of the heart on the left. Percussion reveals expansion of the boundaries of relative cardiac dullness to the left. Features of hemodynamics underlie the main clinical symptom of this defect - a sonorous continuous systolic-diastolic murmur in the second intercostal space on the left ("mill wheel" murmur, "machine murmur"). However, with pathological non-closure of the duct, only systolic murmur appears at first (in the first week), since the difference in pressure in the pulmonary and systemic circulations during this period is small, and cross-discharge occurs only during systole. As pulmonary hypertension develops, the murmur becomes intermittent (systolic and diastolic), then the diastolic component disappears. Accordingly, with an increase in pressure in the pulmonary circulation, the accent of the second tone over the pulmonary artery increases. If prompt surgical assistance is not provided, a systolic murmur may appear at the apex, indicating "mitralization" of the defect, i.e. the formation of relative mitral valve insufficiency. As a manifestation of heart failure with a large left-to-right discharge, tachypnea appears. Congestive wheezing in the lungs, enlargement of the liver and spleen are possible.
The incidence of patent ductus arteriosus is 6-7%. The anomaly is observed in girls 2-3 times more often.
How to recognize patent ductus arteriosus?
ECG allows to detect the deviation of the electrical axis of the heart to the left, signs of left ventricular overload. Changes are possible that characterize the disturbance of metabolic processes in the myocardium of the enlarged left ventricle (negative T wave in the left chest leads).
Radiologically, an increase in the pulmonary pattern corresponding to the size of the arteriovenous shunt, expansion or bulging of the pulmonary artery trunk are detected. The waist of the heart is smoothed out, its left sections and right ventricle are enlarged.
Echocardiographic diagnostics of the defect is performed using indirect and absolute echo signs. When scanning from a high parasternal or suprasternal approach, it is possible to directly visualize the duct or establish a discharge into the pulmonary artery. Measuring the cavities of the left atrium and left ventricle allows one to indirectly judge the size of the shunt (the larger their size, the larger the shunt). It is also possible to compare the transverse size of the left atrium with the diameter of the aorta (normally, this ratio does not exceed 1.17-1.20).
Cardiac catheterization and angiocardiography are indicated only in cases accompanied by a critical degree of pulmonary hypertension, to clarify its nature and the possibilities of surgical treatment.
Differential diagnostics of patent ductus arteriosus is performed with the functional murmur of the "spinning top" on the neck vessels. The intensity of the "spinning top" murmur changes with a change in body position. In addition, the functional murmur can be heard on both sides. The diastolic component of the murmur with patent ductus arteriosus often requires differential diagnostics with aortic insufficiency.
What do need to examine?
How to examine?
Treatment of patent ductus arteriosus
Regardless of the diameter of the arterial duct, the fastest possible surgical treatment is required by ligation or endovascular occlusion (with a diameter of 5-7 mm). In newborns, duct closure can be achieved with indomethacin, a prostaglandin E inhibitor that promotes duct spasm with subsequent obliteration. The dose of indomethacin for intravenous administration is 0.1 mg / kg 3-4 times a day. The effect is better, the younger the child (preferably used in the first 14 days of life).